HomeMy WebLinkAboutBLDG-19-005186 ----
fee.. .
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
,ram
s,
k...,_
,,� CITY Yarmouth I MA DATE 3/5/19 I PERMIT# V--/96V37
JOBSITE ADDRESS 46 Gordon Lane OWNER'S NAME Clarissa Stanton I
GOWNER ADDRESS 46 Gordon Lane ,TEL 508-362-4308 IFAX
TYPE PRINT
OR OCCUPANCY TYPE COMMERCIAL ID EDUCATIONAL ❑ RESIDENTIAL
CLEARLY NEW: RENOVATION:Li REPLACEMENT:Ej PLANS SUBMITTED: YES Li NOD
APPLIANCES 1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 i 14
BOILER 17
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER ! -- 1L jr 1r
DRYER
FIREPLACE
,
FRYOLATOR ' r�
L
FURNACE _j 1 1 _
GENERATOR ! , .' . ----
GRILLE r 1
1, �INFRARED HEATER I
LABORATORY COCKS i _
MAKEUP AIR UNIT _
OVEN
POOL HEATER f_ — 1,
ROOM/SPACE HEATER L , —11--- ____4(__'
ROOF TOP UNIT
TESTr
=_ _,
UNIT HEATER :LI if
_
UNVENTED ROOM HEATER
WATER HEATER I
OTHER .� : L, If
1!
r
u INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES i NO j
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ; v_i OTHER TYPE INDEMNITY ;', I BOND I__I
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER ❑ AGENT Ej
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this applic ' n are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will I compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME James Papasodero LICENSE# 3782 i TURE
MP ___j MGF Q JP❑ JGF LPGI CORPORATION Q# 117 P RTN SHIP❑# I LC❑#F-7J
COMPANY NAME:'ARS Boston 1 ADDRESS 300 Manley Street
CITY W.Bridgewater j STATE MA ZIP 02379 1TEL 508-588-9025
FAX 508-588-1059 CELL EMAIL
L—Rr/
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES